smi2le
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|  | due to chiropractor manipulation in 12%
« Thread Started on Sept 9, 2006, 3:40pm » | |
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Title: Excellent Clinical Outcomes Seen With Oral Anticoagulation and Platelet Inhibition for Intramural Haematoma: Presented at EFNS
"Excellent Clinical Outcomes Seen With Oral Anticoagulation and Platelet Inhibition for Intramural Haematoma: Presented at EFNS"
By Chris Berrie GLASGOW, UK -- September 8, 2006 -- Anticoagulant treatment results in excellent clinical outcomes following extracranial and intracranial cervical artery dissection, according to a study presented here at the 10[th Congress of the European Federation of Neurological Societies (EFNS).
These findings were presented by Nicola Brüning, a medical student under the supervision of principal investigator Alexander Hartmann, MD, professor of neurology, Centre for Radiology "Radiologie im Haydnhaus", Bonn, Germany.
Cervical artery dissection is a common cause of stroke, particularly in young adults, and initial treatment with an anticoagulant is generally the recommended treatment, Brüning indicated in a presentation on September 4th.
However, little data is available on the safety and efficacy of anticoagulation followed by long-term platelet inhibition in patients with cervical artery dissections. Therefore, Dr. Hartmann and colleagues conducted their study to assess the clinical outcomes of 72 consecutive patients (mean age, 44.8 years; male, 44.4%) with dissections of the extracranial or intracranial cervical arteries.
Diagnosis was established using ultrasound and magnetic resonance imaging (MRI). Sixty of these patients showed dissection of a single artery, 7 had multiple dissections, and 5 had recurrent dissections. The anterior circulation was involved in 51 patients (25 right, 26 left intracranial cervical artery), the posterior in 36 (17 right, 20 left vertebral artery), and both the carotid and vertebral arteries in 6 patients. Four patients had intracranial artery dissections. The initial imaging also showed that 42 of the patients had a brain infarct.
The causes of the dissections were spontaneous in 61%, due to chiropractor manipulation in 12%, sports in 11%, trivial trauma in 4%, post-traumatic in 8% and intragenic in 4%.
On initial administration, all patients were evaluated with ultrasound and cerebral circulation time (CCT), cMRI, magnetic resonance angiography (MRA) and/or angiography of the neck vessels and brain. Follow-up time for the second complete work-up was 35.2 months, which included ultrasound, MRI, routine blood tests and coagulation studies, and clinical tests.
The neurological course was scored according to the National Institutes of Health Stroke Scale (NIHSS), the Barthel Index and the modified Rankin Scale (mRS).
Parenteral anticoagulation (mean duration, 21 days) was used in 58 of the patients, followed by oral anticoagulation (mean duration, 9.2 months) in 54 of these patients. Among the remainder, 4 were treated with oral anticoagulation alone and 3 with platelet inhibitors only. Four received no medical treatment.
One subarachnoid haemorrhage occurred during the parenteral anticoagulation, while 4 patients had re-infarcts, and 2 had a recurrent dissection during anticoagulation or platelet inhibition.
For the neurobiological and ultrasound evaluations, the MRI, MRA, ultrasound and angiography showed varying sensitivities for confirmation of dissection, with only 13 cases diagnosed by angiography. These analyses demonstrated occlusions, stenosis and pseudoaneurisms of the intracranial cervical artery and venous artery. Intramural haematoma were also detected during the acute anticoagulation phase in 40 patients (anterior circulation, 26; posterior, 14). These were reduced in the follow-up MRI (anterior 7; posterior 4).
The results of follow-up MRI/MRA indicated that there had been recanalisation in 60% of the previous dissection patients, thus returning their vascular morphology to a normal condition, Brüning noted.
At the follow-up clinical evaluation there were significant improvements according to all of the assessment scales. Normal clinical findings on the NIHSS scale (NIHSS 0) at follow-up were seen in 73% of patients, which paralleled the initial normal plus mild (NIHSS 1-4) assessments (71%), with the consequent reduction at follow-up in the mild and moderate (NIHSS 5-10) scores.
Similarly, the initial mRS assessments showed no patients as normal (mRS 0), while at follow-up the mRS 0 levels had increased to above 40%, specifically at the expense of the mRS 2-6 levels.
These data demonstrated excellent clinical outcomes following oral anticoagulation and platelet inhibition, Brüning concluded, with particular emphasis on complete recanalisation in 60% of patients and disappearance of intramural haematoma in the majority of patients. This was accompanied by only rare bleeding complications, thus indicating this treatment to be both effective and safe following cervical artery dissection, the presenter said.
[Presentation title: Longtime Outcome of Patients With Extra- and Intracranial Cervical Artery Dissection After Anticoagulation. Abstract P2004]
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diane
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| | Re: due to chiropractor manipulation in 12%
« Reply #1 on Sept 9, 2006, 4:50pm » | |
Seventy-two (72) patients, young adults, with stroke. Twelve percent (12%) were caused by chiropractors. That's one in six.
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lawman
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| | Re: due to chiropractor manipulation in 12%
« Reply #2 on Mar 9, 2007, 6:47pm » | |
The Journal of Neurology has published a German Vertebral Artery Dissection Study Group report about 36 patients who had experienced vertebral artery dissection associated with neck manipulation [Reuter U and others Vertebral artery dissections after chiropractic neck manipulation in Germany over three years. Journal of Neurology 256:724-730, 2006]
Other countries Md's are looking at the issue as well, this came out in Jan 2007.
I do not have the background to critique the study. Others do, have at it.
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